Just as we are programmed to anticipate the first arrival of our periods with a combination of fear and panic, so too do we anticipate their disappearance. But the years leading up to menopause (which doesn’t officially commence until you go 12 consecutive months without menstruating; 51 is the average age) can, thanks to continual hormonal shifts, pose their own set of challenges.
These are challenges that many women—this one included—feel wholly unprepared for. In a cruel twist, they often mirror what many of us endured during our teenage years. It’s like being in puberty, but in your 40s. You’re going through this imbalance where your body is starting to become asynchronous in terms of the way your hormones are being produced.
And while we are becoming increasingly familiar with the term perimenopause (defined as the transitional stage before menopause), there is still plenty of confusion around what is happening to our bodies during this time, particularly in regard to our periods.
First, a few basics: In a typical menstrual cycle, ovaries produce a hormone called estrogen, which builds up the lining of the uterus, where a pregnancy could implant. Halfway through your cycle, you ovulate. When you ovulate, a mature follicle carrying an egg is released and, if you don’t get pregnant, that triggers production of the hormone progesterone, whose purpose is to shed the lining of the uterus and also regulate your mood. (It’s often referred to as the feel-good hormone.)
Much like when you’re a teenager, in your 40s you may not necessarily ovulate every month. What does that mean? You end up being in a state of estrogen dominance, which thickens the uterine lining and can result in what some of us have unaffectionately dubbed a crime-scene period—one marked by heavy flow and extreme pain. A 40-something’s decline in progesterone can lead to roller-coaster moods, plus insomnia and disrupted sleep, all made worse by the common accompanying dip in serotonin (the pleasure hormone).
Women in their 40s who complain of heavy bleeding may find themselves being prescribed birth control, something I liken to putting a Band-Aid over your symptoms rather than addressing the root cause of an imbalance. I always caution patients against birth control pills or synthetic hormones for a long period of time because of the risk factors for stroke, blood clots, and mood changes that accompany it. When used for an extended period of time, the pill may impact menstrual periods via the recalibration of hormonal receptors and hormone production in endometrium, ovary, pituitary, hypothalamus, and other tissues.
There are ways to ease the hormonal transition of your 40s. And if you can start that easing early, even better. Developing healthy lifestyle habits in your 30s is important because every decade is preparing you for the next one.
When it comes to diet, consuming sugar, alcohol, and gluten in moderation is especially important since insulin resistance can develop during perimenopause, causing fatigue, insomnia, and hot flashes. Also, ensure you’re getting adequate protein (60 to 100 grams a day). I find the protein intake among most of my female patients is insufficient, and this can be a problem for hormonal health.
Good sleep hygiene and adequate hydration (from both water and food) are also key for such a transitional moment. With exercise, movement is vital but consider swapping high-intensity cardio for more resistance training. This approach is often more effective at reintegrating and sustaining well-being than fast-paced workouts that can overstimulate the already-stressed adrenal glands and nervous system and bypass structural and joint integrity during a critical life transition.
There are a number of supplements that will help support you hormonally in your 40s. For easing symptoms, I recommend black cohosh (a nonestrogenic herb), maca (an Andean root), and vitex (also known as chasteberry). Vitex agnus-castus fruit, also known as chasteberry, specifically elevates luteinizing hormone levels, which can enhance the luteal phase of the cycle as it wanes during the transition to menopause.
If you’re struggling with weight gain and fatigue, I recommend adrenal-support supplements like ashwagandha, an Ayurvedic adaptogenic herb, and also berberine and inositol to improve insulin resistance.
Readying yourself for something that can be wildly unpredictable can feel like a daunting task. Perimenopause is actually more challenging clinically for patients in terms of their symptoms than menopause. It doesn’t help that there’s no set time frame for the shift. Women could be in perimenopause for a varying length of time and it could be hardly noticeable or it could be eight years of slow changes. Embrace the fact that a change is coming, talk about it, and, most importantly, ask for help. You do not have to just live with it.
We recommend a personalized approach to the treatment of perimenopause. Bioidentical hormone replacement therapy for women may help any woman whose hormones are out of balance. However, the most common time women seek bioidentical hormone replacement therapy is when they’re experiencing menopause.
Women typically experience three stages of menopause—perimenopause, menopause, and post-menopause. There are also rare instances regarding women who have never had balanced hormones, often causing excessively uncomfortable menstrual cycles and extreme mood swings.
Our personalized method of bioidentical hormone replacement therapy for women will help address the cause of these issues and provide our patients with optimal health and longevity. To learn more, request an appointment online or over the phone today at our Santa Monica, California, office.
